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LUNG + RENAL STEP 2 > Renal 2 > Flashcards

Renal 2 Flashcards

1
Q

MCC of painless hematuria (evaluation)

A

bladder cancer

if older than 35 –> CT and cytoscopy

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2
Q

gross hematuria - prostate?

A

BPH

not cancer

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3
Q

hematuria - best initial test

A

urinalysis to rule out and confirm microhematuria (more than 3 RBCs)

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4
Q

reccomendations for patient with renal calculi

A
  1. increased fluids
  2. low sodium
  3. normal calcium
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5
Q

medication that cause urinary retention (and manegment)

A

anticholinergics

stop them + cathetirization

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6
Q

osmolar gap?

A

measured serum osm - calculated serum osm

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7
Q

causes of combination of osmolar gap and and high anion gap met acidosis

A

acute ethanol (MC)
methanol
ethylen glycol

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8
Q

methanol toxicity

A

blindness

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9
Q

oliguria means

A

less than 250 ml in 12 hours

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10
Q

management of acute oliguria

A

bedside bladder scan to assess for urinary retention

  • retention (MORE THAN 300 ml) –> catheter to decompress –> serum + urine bioch +/- image –> treat underling
  • no retention –> serum + urine bioch +/- image:
    a. pre-renal (IV fluids or treat underling)
    b. renal cause -> treat underling
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11
Q

hepaternal vs pre-renal

A

hepatorenal does not respond to fluids

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12
Q

hepatorenal syndrome treatment

A
  1. address precipitating factor
  2. splachninc vasoconstrictor
  3. liver transplantation
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13
Q

MCC of death in dyalisis patients

A

Cardiovascular

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14
Q

MCC of death in patients with renal transplantation

A

cardiovascular

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15
Q

MC extrarenal manifestation of ADPKD

A

hepatic cysts

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16
Q

GI complication of ADPKD

A

colonic diverticula

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17
Q

aspirin intoxitation - ph

A

normal

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18
Q

GI symptoms of ureteral colic

A

vagal reaction –> ileus

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19
Q

medication to fascilate stone passage

A

a1 blocker (tamsulosin) –> act on distal ureter

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20
Q

bladder cancer screening

A

not recommended (even if RFs)

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21
Q

management of ureteral stones

A

symptomatic relief –> urosepsis, acute renal failure or complete obstructiion?
yes –> urology consult
no –> stone siize:
less than 10 mm –> hydration pain control, a blocker
bigger than 10 –> urology consult
uncontrolled pain or no stone passage in 4-6 weeks –> urology consult

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22
Q

MC nephrotic syndrome associated with thromboembolism

A

membranous nephropathy

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23
Q

lithium - hemodialysis?

A

if more than 4, or more than 2.5 with signs of toxicities

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24
Q

simple vs malignant renal cyst in contrast CT

A

only malignant has enhancement

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25
Q

causes of asterixis

A
  1. Hepatic encephalopathy
  2. Uremic encephalopathy
  3. CO2 retention
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26
Q

SIADH - management

A

fluid restriction +/- salt tablets
if severe: hypertonic (3%) saline
if refractory –> demeclocycline

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27
Q

GI loses - K+

A

both vomiting and diarrhea causes hypokelamia

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28
Q

medications that can cause hyperkalemia

A
  1. β-blockers
  2. ACEi
  3. K+ sparing diuretics
  4. digitalis
  5. cyclosporin
  6. heparin
  7. NSAID
  8. succinylcholine
    9 . Trimethorpime
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29
Q

NSAID mediated hyperkalemia - mechanism

A

decreases renal perfusion –> decreased K delivery to the collecting ducts

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30
Q

Heparin mediated hyperkalemia - mechanism

A

blocks aldosterone production

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31
Q

Cyclosporine mediated hyperkalemia - mechanism

A

blocks aldosterone activity

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32
Q

Trimethoprime mediated hyperkalemia - mechanism

A

blockage of epithelium Na2+ channel in the collecting ducts –> also blocks the creatinine secretion (artificially), without affecting the GFR

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33
Q

causes of edema in nephritis

A

FLUID RETENTION

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34
Q

urinary retention due to anticholinergics

A

detrusor hypocotractility

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35
Q

medications that causes SIADH

A

SSRI, carbamazepine, Cyclophosphamide, NSAID

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36
Q

psychiatric disorder associated with 1ry polydipsia

A

schizophrenia

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37
Q

nephrotic syndrome can cause accelerated atherosclerosis - mechanism

A
  1. loss of anthothrombin III
  2. due to low albumin, liver overproduce lipid proteins
    affects veins more (esp renal veins)
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38
Q

severe hyperkalemia - best initial step

A

calcium gluconate –> then insulin, glucose, HCO3-, β-agonists

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39
Q

hyperkalemia - ECG

A
  • tall peaked T waves with short QT
  • PR prolongation + QRS widening
  • No P waves
  • conduction block, ectopy, or sine wave pattern
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40
Q

metabolic acidodis - give HCO3-?

A

if ph less than 7.1

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41
Q

hypokalemia in alcohoics is refractory - why

A

hypogmagnesemia (removal of inhibition of renal excretion)

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42
Q

stones - best initial test

A

U/S (NOT URINALYSIS)

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43
Q

best options for renal transplantation

A

in order

  1. living related donor
  2. living unrelated
  3. cadaveric
44
Q

drug induced intestitial nephritis - treatment

A

stop the related drug (not steroids)

45
Q

glomerular vs non glomerulal hematuria regarding type

A
  • glomerular usually microscopic, also proteins and casts adn dysmorphic RBCs
  • nonglomerular usually gross
46
Q

SE of acyclovir on kidneys (treatment)

A

crystaluria –> renal tubular obstruction

administer fluids with the drug

47
Q

etiology of crystal induced acute kidney injury

A 
acyclovir 
sulfonamides
MTX
ethylene glycol
protease inh
Uric acid
48
Q

clinical presentation of crystal induced acute kidney injury

A

usually asymptomatic
AKI in less than 7 days from the starting drug
hematuria, pyuria, crystals

49
Q

treatment of crystal induced induced acute kidney injury

A

stop medication
fluids
loop duretics

50
Q

urinalysis - blood?

A

cannot distinguish Hb from myoglobin

51
Q

post-void redidual volume in obstruction

A

more than 50 ml in men and 150 in women

52
Q

renal transplantation - treatment if signs of rejection

A

IV steroids

53
Q

renal transplant dysfunction - causes

A
  1. utreteral obstruction (U/S to rule out)
  2. cyclosporine toxicity (drug level)
  3. vascular obstruction (renal biopsy)
  4. acute tubular necrosis
    acute rejection is treated with IV steroids
54
Q

treatment of hypernatriemia

A

hypovolemic: O.9% saline (but if mild can give 5% dextrose in 0.45 saline)
euvolemic: hypotonic
correction no more than 1 meq/L/h

55
Q

MCC of renal artery stenosis

A

HTN

56
Q

cocaine - acute renal failure?

A

due to rhabdomyolisis (CPK causes ARF if more than 20.000)

57
Q

the quickest way to low the K+

A

insulin

58
Q

evaluation of met alkalosis

A

urine chloride
low –> vomiting / NG aspiration, prior diuretics (SALINE RESPONSIVE)
high –> hypervolemia (aldosterone) (SALINE UNRESPONSIVE)
hypovolemia/evolemia: current diuretics (SALINE RESPONSIVE) Barrter, gitelman (SALINE UNRESPONSIVE)

59
Q

Most sensitive screen for nephropathy

A

RANDOM urine for microalbumin/creatinine ratio

24h is more accurate but it is inconvenience

60
Q

advantages of renal transplantation over dyalysis

A
  1. better survival + quality
  2. autonomic neuropathy stabilzes or improves in diabetics
  3. return to normal endocrine, sexual and reproductive functions
  4. anemia, bone disease and hypertension better control
61
Q

evaluation of hyponatremia

A

serum osm more than 290?
yes –> marked hypogl / advanced renal failure
no –> urine osm less than 100?:
- yes (polydipsia, malnutriotion)
- no –> check urine sodium
if if less than 25 –> SIADH, adrenal ins, hypoth
if it is more than 25 –> vloume depltion, cirrhosis, CHF

62
Q

how to correct low Na+

A

3% salide solution

not exceed 0.5 mEg/L/hr to

63
Q

characteristic of varicoceles due to underlying mass pathology

A

unilateral varicoceles that fail to empty when a patient s recumbent

64
Q

mechanism of hepatorenal syndrome

A

splanchnic arterial dilation, decreaesd vascular resistance, local renal vasocnstriction with decreased perfusion

65
Q

postictal lactic acidosis

A

anion gap metab acidosis following a tonic clonic seizure –> resolves in 90 mins without treatment

66
Q

post-streptoc vs IgA nephropathy regarding complement

A

low C3 in post-strept

normal in IgA

67
Q

reduce Ca intake - stones

A

reduce ca intake increases oxalate absorption

68
Q

GFR in DM

A

increases in the beginning (hyperfiltration)

then goes down

69
Q

recommendations for blood tranfusion

A

under 7: always
7-8: if cardiac surgery, HF, oncology patients in treatment
8-10: symptomatic anemia, noncardiac surgery, ongoing bleeding, ACS

70
Q

indications for urgent dialysis

A
  1. refractory acidosis with ph under 7.1
  2. volume overload refractory to diuretics
  3. symptomatic uremia (bleeding, encephalopathy, pericarditis
  4. ingestion: toxic alcohols, salicylate, lithium, sodium valproate, carbamazepine
  5. elect abnormalities: severe or symptomatic hyperkalemia refractory to medications
71
Q

skin in cyanide toxicity

A

cherry red flashing, cyanosis comes later

72
Q

treatment of hypertension and renal artery stenosis

A

ACI are indicated for iniitlay therapy
renal artery stenting or surgical revasculization is resewed for patients with resistant HTN or recurrent flash pulm endam and/or refractory HF due to severe hypertension
BE VERY CAREFUL IF BILATERAL

73
Q

MCC of abnormal hemostasis in patients with chronic renal failure / characteristics / treatment

A

platelet dysfunction
BT in elevated. PT and PTT are normal
desmoprasin is the treatment
(no transfusion)

74
Q

nephrotic syndrome - anemia?

A

iron resistant microcytic hypochromic anemia

DUE TO TRANSFERRIN LOSS

75
Q

Most frequent vessel manifestation of nephrotic syndrome

A

venous thrombosis

76
Q

asymptomatic or mild hypercalcemia

A

no immediate treatment required

avoid thiazide, lithium, volume depletion + prolonged bed rest

77
Q

moderate hypercalcemia - treatment

A

usually no immediate treatment required unless symptomatic

- similar to severe

78
Q

severe hypercalcemia - treatment

A 
short term (immediate) treatment
- normal saline + calcitonin
- avoid loop diuretics unless volume overload 
Long term
- bisphosphonate
79
Q

pyelonephritis treatment

A
  • outpatient: fluoroquinolones
  • inpatient: IV antibiotics (fluoroquinolone, aminoglycoside +/- ampicillin)
  • urine culture prior to treatment
80
Q

uncomplicated cystitis - treatment

A
  • Nitrofurantoin for 5 fays (avoid if pyelonephritis or Cr clearance less than 60)
  • TMP - sxm for 3 days
  • fosfomycin (single dose)
  • fluoroquinolones (2nd option)
  • Culture only if initial treatment fails
81
Q

complicated cystitis - treatment

A
  • fluoroquinolones (5-14d),
  • extended spectrum antibiotics (ampicillin/gentamycin) for for severe
  • culture before
82
Q

when is complicated cystitis

A

DM, kidney disease, pregnancy immunocompromised, urinary tract obstruction, hopsital acquired, assoiacetd with procedure, indwelling foreign body

83
Q

treatment of uric acid stones

A
  1. hydration
  2. alkalinization of urine (POTASSIUM CITRATE)
  3. low-purine
    diet
  4. allopurinol if resistant
84
Q

how to alkalinize urine in uric acid stones

A

potassium citrate

85
Q

grades of hypercalcemia - grade

A

severe (more than 14) or symptomatic)
moderate: 12-14
mild or asymptomatic (less than 12)

86
Q

amiloride mediated hyperkalemia - next step

A

change the medication

low diet K+ does not change anything

87
Q

analgesic nephroapathy

A

MC form of drug induced chronic renal failure

Papillay necrosis + chronic tubulointestitial nephritis are the MC pathologies seen

88
Q

bladder outlet obstruction (eg. from BPH) - next step

A

renal U/S to assess function and check for hydronephrosis

89
Q

Interstitial cystisis (bladder pain syndrome) - epidimiology

A
  • More common in women

- associaed with psychiatric + pain disorders (eg. fibromyalgia)

90
Q

interstitial cystitis (bladder pain syndrome) - clinical presentation

A
  1. bladder pain with filling, releif with voiding
  2. urinary frequency + urgency
  3. Dyspareunia
91
Q

interstitial cystitis (bladder pain syndrome) - diagnosis

A
  • bladder pain with no other cause for 6 or more weeks

- normal urinalysis

92
Q

interstitial cystitis (bladder pain syndrome) - treatment

A
  1. not curative: focus to improve quality of lide
  2. behavioral modification, avoid triggers, physical therapy
  3. TCA, pentosan polysulfate sodium
  4. Analgesics for acute exacerbations
93
Q

which 2 lab values provide the best picture for acid-base status

A

pH + pCO2

HCO3- can be calculated fro henderson hesselbach equation

94
Q

acute kidney injury causes acidosis - anion or non anion gap

A

both:
anion gap: uremic toxins
non-anion gap: impaired acid excretion

95
Q

Obstructive uropathy - presentation

A
  1. flank pain
  2. low-volume voids iwth or without occasonal high-volume voids
  3. if bilateral: renal dysfunction
96
Q

Genitourinary manifestations of diabetic autonomic neuropathy

A
  1. erectile dysfunction + retrogratde ejaculation in men, decreased libio + dyspareunia in owmen
  2. decreased ability to sense full bladder leading to incomplete emptying + decreased urination
  3. eventu`al reccurent UTI and /or overflow incontinence (dribbling, porr urinary streem
97
Q

urate stones shape

A

needle

98
Q

how to evaluate uric acid stones

A

CT or U/S or IV pyelography

99
Q

hyperakalemia - acute therapy if

A
  1. more than 7
  2. ECG changes
  3. rapid rising
100
Q

renal stones - high volume urination?

A

intermittent episodes of high volume urination can occur when obstruction is overcome by a large volume of reatained urine (post-obstructive) –> can lead to potassium wasting and dehydration –> weakness

101
Q

postoperative oliguria with inconclusive scan - next step

A

folley

102
Q

postoperative oliguria means

A

less than 0.5ml/kg/hr

103
Q

suspect renal ca - next step

A

CT

104
Q

IGA nephropathy - when is the resp infection

A

concurrent

105
Q

aspirin ph - process

A

resp alkalosis early –> metabolic acidosis later

LUNG + RENAL STEP 2 (5 decks)

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